How to fill out the Admission Application Card for Doctoral Course of Health Sciences,
Graduate School of Health Sciences, Kumamoto University
1. Type of examinations“Type of examinations”“Application No.*”

Circle the type No. that applies.
Do not fill in.

2. Major of your choice, etc.
“Major of your choice”

No need to fill in.

3. Name“Name in English”

Enter your first name and family name separately in the respective spaces.

4. Date of birth, age, and gender“Date of birth”“Age”“Gender”

Enter your date of birth in the relevant space in an 8-digit number in order of year (4digits) followed by month (2 digits) and date (2 digits)(e.g. Born on May 10, 2000 → 20000510)
Enter your current age.
Circle the number that applies.

5. Eligibility for Application“University from which you graduated”

Circle one of the numbers for “National,” “Public” and “Private” that applies to theuniversity from which you graduated or are expected to graduate. Then enter theinformation regarding the university and graduate school in each space. If you have
graduated from an educational institution other than a university, enter as muchdetailed information on the institution as possible.
“Identification code of your university”
Enter the identification code of the university to which your graduate school isaffiliated (left-justified), referring to Table 2.
If your academic record does not include a graduate school, enter the code of theuniversity from which you graduated.
If no code on the table corresponds to your university, enter the 6-digit code 999999.
(e.g. Kumamoto University → 0384)“Expected (to complete) or Complete”
Circle the number that applies.
“Year and month of (expected) completion” Enter the year and month of (expected) completion in a six-digit number in order ofyear (4 digits) followed by month (2-digits).
(e.g. Completed (expected to complete) in March 2025→ 202503)

6. Address“Current address”“Emergency contact address”
7. Others“Working adult applicants”“Type of international students”※ Former student No.

Reverse side: Resume“Academic background”

Enter your current address, postal code and phone number.
Enter your contact information where you can be reached in an emergency except
for the current address, if you have.
If your situation after enrolled in this Graduate School will match the description
below, circle “1”; and if it does not, circle “2.”Working to make a constant income from salary, wage or compensation.
(Including those who have resigned from a company and homemakers)
If you are an international student, circle the number of the description that applies.
If not applicable, do not circle any number.
If you are currently enrolled in a school/department of Kumamoto University as a
research student or other status and are applying to the Graduate School of Health
Sciences for admission after your graduation/completion, enter your current student
No. If not applicable, leave the space blank. If you are expected to complete theMaster’s Course of the Graduate School of Kumamoto University and applying forthe entrance examination, please see the separate document “Screening Guideline forApplicants from Master's Course.”

International applicants must fill out the form from a school equivalent to a Japaneseelementary school. For all others, please fill in from high school graduation.

AY2025 Admission Application Card for Graduate School of Health Sciences,
Kumamoto University (Doctoral Course)
1. Type of examinations
Graduate School ofHealth Sciences

Doctoral Course

121.

Term of admission

03

Type ofexaminations

01

2.

General entrance
examination
International student
entrance examination

Application
No.*K

2. Major of your choice
Major of yourchoice

Program of Health Sciences

Major
code01

3. NameFirst nameName in English

Last name

4. Date of birth, age, and gender
Date of birth

Age

Day

MonthGender

1. Male2. FemaleYear

5. Eligibility for Application (university from which you graduated/are expected to graduate)
Location of youruniversity

Year and month ofgraduation
National
PublicPrivate

Information regarding
your university

School/Department

Course/Department

University

Location of yourgraduate school
NationalPublicPrivate

Information regarding
your graduate school

Affiliated Graduate School ofUniversity
Expected(to complete) or
Completed

Identification code ofyour university

1. Expected
2. Completed

Master’s Course
Pre-doctoral Course

Major

Year and month ofcompletion

6. Address
Postal code:
Current address

Emergency contact
address (workplace,mobile phone, etc.)

phone
E-mail()＠phone()Postal code:

7. Others
Working adultapplicants

1. Yes2. No

Type ofinternational
students

1. Government-sponsored
3. Prefecture-sponsored
5. At own expense

2. Dispatched by the government
4. Municipal-sponsored※Former student No. (for Graduates of Kumamoto University)
Former student
No.

Notes: 1. Fill out this Admission Application Card clearly in block letters using a black pen or ball-point pen, after
carefully reading “How to fill out the Admission Application Card” on page 11.
2. Do not fill in “Application No.*”.
3. Please also fill out the reverse side.

Personal history
Admission year/monthType

Academicrecord（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）

Employment （record

Description

Graduated fromHigh SchoolYear/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）

Rewards andpunishments （Year/Month）（Year/Month）

Notes: 1. Do not omit any required information regarding “Personal history”.
2. As for the academic record, international applicants should enter all of their school education history,
and other applicants should enter their academic history from their high school graduation.
3. Admission of those who have made any false statement in their personal history may be revoked.

AY2025 Graduate School of Health Sciences, Kumamoto University (Doctoral Course)
Photo Card for Entrance Examination
Type ofexaminations

General entrance examination / International Student entrance examination

Application No.

*KPhotoName inEnglish(4 cm × 3 cm)
Photo taken within
three months before

Major ofyour choice

application, frontal

Program of Health Sciences

portrait, no hat

Note: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies.

------------------------------------------------- Do not separate these forms.-------------------------------------------------AY2025 Graduate School of Health Sciences, Kumamoto University (Doctoral Course)
Admission Ticket to an Entrance Examination
Types ofexaminations

General entrance examination / International student entrance examination

Application No.

*K
Photo

Name inEnglish(4 cm × 3 cm)
Photo taken within
three months before

Major ofyour choice

application, frontal

Program of Health Sciences

portrait, no hat

Note: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies.
3. This ticket must be placed on the desk and visible to the supervisor when you are taking the examination.
4. This ticket should be kept until completing the enrollment procedure.

------------------------------------------------- Do not separate these forms.-------------------------------------------------AY2025 Graduate School of Health Sciences, Kumamoto University (Doctoral Course)
Address Card for Entrance Examination
Type ofexaminations

General entrance examination / International student entranceexamination(Postal code)

Mailing address(Ward/Town/Village)
for notificationof acceptance,etc.
(Applicant’s name)Note: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies.

Application No.

*K(Pref.)(Street No./Bldg./Room No.)

(City/County)(C/O, if any)Important notes:
1. You must bring your Admission Ticket with you and place it on the desk while taking an examination.
2. Please turn off your mobile phone(s).
3. Latecomers for the examination due to unavoidable circumstances will be allowed to take theexamination only if it is within 30 minutes from the meeting time.

Date of examination

Subject

August 23 (Fri), 2024

Oral examination

TimeVenue
Graduate School of HealthSciences, Kumamoto
University

Note: 1. The time of each examination will be announced when the examination voucher is sent.

Application No.

*K

Summary of Master's Thesis(or Report on Research Progress)
Graduate School of Health Sciences, Kumamoto University (Doctoral Course)
Name

Major of your choiceNote: Do not fill in the space marked with an asterisk (*).

Program of Health Sciences

Application No.

*K

Reason for Application & Desired Research Form
Graduate School of Health Sciences, Kumamoto University (Doctoral Course)
Name

Major of yourchoice

Academicsupervisor

Supervisor’ssignature

Program of Health Sciences

I. Reason for application (Reason for choosing the Doctoral Course of the Graduate School of HealthSciences)

II. Research of your choiceNotes: 1. Do not fill in the space marked with an asterisk (*).
2. Be sure to have your academic supervisor’s signature on the form before submitting.

Application No.

*K

AY2025 Graduate School of Health Sciences, Kumamoto University(Doctoral Course) Application Form for Screening of Eligibility for ApplicationDay/

Name in English
Signature

Date of birthYear//(ageGenderMaleFemale)Contact information(Phone number,etc.)

Address

Major of your choice

Program of Health Sciences

Period(from admission to graduation)

AcademicrecordMonth/

FromYear/Month（ToYear/Month（）

FromYear/Month（ToYear/Month（）

From
Year/Month（ToYear/Month（）

From
Year/Month（ToYear/Month（）

From
Year/Month（ToYear/Month（）

From
Year/Month（ToYear/Month（））））））

Names of companies, etc.

FromYear/Month（ToYear/Month（）

FromYear/Month（ToYear/Month（）

From（Year/MonthYear/Month

Qualifications (degrees)）

PeriodEmployment Torecord（Names of schools (department/course, etc.)

Tasks/duties (research)））））

FromYear/Month（ToYear/Month（）

FromYear/Month（ToYear/Month（）

FromYear/Month（ToYear/Month（））））

Notes: 1. Do not fill in the space marked with an asterisk (*).
2. If a single page of this form is not enough for your record, you may duplicate it.
3. If you have a Certificate of Research Participation, Practicing Certificate, Certificate of Achievement or any
other similar documents that can be referred to in screening, please submit them along this form.